Surgical treatment of giant basilar artery aneurysms

Microsurgical clip reconstruction of a giant basilar artery aneurysm is considered one of the most challenging operative endeavors in neurosurgical practice. The operation, when carried out successfully, requires both surgical skill and intraoperative judgment. The authors present the surgical approaches and techniques used for the treatment of giant basilar artery aneurysms. In particular, the authors emphasize the extended lateral transsylvian approach, an exposure developed by the senior author (H.H.B.). In addition, this paper details the methods of preoperative evaluation, skull base approaches, proximal occlusive techniques, and the use of cerebral revascularization strategies as an adjunct in aneurysm obliteration.